Making Sense of Pregnancy: What Experts Want you To Know About Your Body

Last week we talked about the technology, originally used to look at inflammation in the brain and heart, applied to the placenta. This amazing form of MRI, which is both non invasive and safe, allows for real time information about inflammation in a pregnancy in progress. Today I'll finish my conversation with Dr. Yong Wang about what he and his team found in the study that used this technology in pregnant patients.  

The placenta is critically important for the success of a pregnancy, being the physical connection between the mother's body and the developing fetus. Defects in the placenta tend to have significant consequences for the pregnancy and the fetus, including things like preeclampsia, preterm birth and maybe also congenital heart defects. So understanding what's going on in the placenta before these conditions develop has enormous potential to drastically improve the health of the fetus and future child. But figuring out that a problem is a foot before physical signs of that problem show themselves in the form of preterm contractions or high blood pressure in pregnancy has been a challenge. Today I'm talking to a researcher I'm describing as the Magellen of pregnancy, an explorer of sorts showing us new details of changes in inflammation during pregnancies in progress that we haven't been able to see before by adapting a specific type of MRI to image inflammation in the placenta in real time.

To read the paper, you can find it here: https://pmc.ncbi.nlm.nih.gov/articles/PMC11698687/

This week we will focus on what in G-ds good name is going on in the uterus during your cycle. I don’t think I’m going too far out on a ledge to say that most of us consider our period an inconvenience at best, but when you hear some of the details of what’s actually going on, you may look at it differently. what’s happening in your uterus each month reads like science fiction–cells following hormone signals with a cult like fervency, multiplying like crazy and transforming into other cell types, building blood vessels on the fly and awakening glands to produce uterine milk. Not only are these cells responding to chemistry, to hormones, but they are also responding to the mechanical signals around them– they feel and respond to the physical pressure of the other cells around them–and it turns out these magic tricks, which, when they are working, can help your body to produce a new human life, and when they aren’t working may significantly contribute to; the risk of miscarriage, the risk of pregnancy complications (endometrial spectrum disorder) and, but also, at the same time, these cells may provide serious prospects for regenerative medicine as a “cure” for some sources of infertility. 

Here's a link to the episode on implantation: https://podcasts.apple.com/us/podcast/your-placentas-origin-story/id1779600854?i=1000701864045

Pregnancy can appear smooth when everything, or nearly everything goes according to plan--basically. But if you're part of the group of people for which it has not gone smoothly, in pursuit of what may have gone wrong, you find that this process is actually ridiculously complicated.

One opportunity to appreciate this comes with IVF when doctors efforts to manage more aspects of this process can lead to insights about how it works.

Today's guest talks about a theory that might explain a constellation of infertility, problems from repeated implantation, failure to preeclampsia, and even endometriosis.  

This week’s episode is the ‘Making Sense of Pregnancy’ version of the broadway play (and now movie) Wicked: it provides the back story of a critical character in pregnancy that you likely didn’t know enough about. 

It also serves as a useful introduction to next week’s show that features the work of a scientist who is trying to untangle one possible path to preeclampsia that seems to arise in women who undergo a certain form of IVF.  

And that story hinges, critically on this temporary organ you are making every month called the corpus luteum. Today I’ll share the current state of research on how the corpus luteum is formed and what it does or, alternatively, all the things I didn’t know about how these temporary organ, critical for the survival of our species, is formed and managed inside a woman’s body.

If we wanted to bury the phrase “bounce back” to describe our expectation about how a body should respond in postpartum, I think today’s conversation can effectively do that. 

I talk to a researcher who has gathered the largest sample of data about women, before, during and after pregnancy, tracking 76 different lab values for 300,000 women between 2003 and 2020. His work shows the significant changes to physiology during pregnancy, and importantly, how long it takes different physical aspects to recover from pregnancy. 

Spoiler alert: the vast majority of tests take more than 3 months to recover. 

We’ll also talk about how some complications may well be related to preexisting issues, as seen in the preconception labs.

You can find more of Dr. Alon's work here: https://www.weizmann.ac.il/mcb/alon/

The previous episode that examines a blood biomarker for depression with Dr. Jennifer Payne: https://podcasts.apple.com/us/podcast/can-we-predict-postpartum-depression-from-inside-the/id1779600854?i=1000711126548

When it comes to categorizing pregnant women as high or low risk, we leave so much information on the table--which keeps us limited to the model where doctors use broad averages to triage care for pregnant women. Age is a definitive way to categorize pregnant women. On average a woman who is 35 or older is considered of advanced maternal age and may be watched more carefully throughout the pregnancy. But the number 35 is no magic line crossed; 

If you have encountered gestational hypertension or preterm birth in a previous pregnancy, you are “at risk” to experience it again, but that view of a second pregnancy is a rough cut of the information we could be using.

If you knew more about your body’s response to pregnancy, could you turn that risk down?  Some aspects of personalized medicine have reached other areas of health care, and it now seems to be reaching pregnancy.

In today’s episode I finish my conversation with Professor Benjamin Smarr, about his studies of pregnant women using data collected through an activity tracker. He shares some of his surprising results about miscarriage and age in pregnancy.

Find more of Professor Smarr's work here: https://smarr.ucsd.edu/ 

In the olden days, women measured something called basal body temperature (BBT), which is core temperature, to track ovulation by measuring their temperature right when they wake up--it's the first thing you'd do-- with a special thermometer that measured to at least one-tenth of a degree, and record it on a chart  (maybe on your phone, maybe on paper) to identify a subtle temperature shift. But those were the horse and buggy days of biohacking. Now we can wear a ring that provides a continuous read out of your temperature and sends it to an app on your phone; and not only can it tell you if you are ovulating, it may be able to tell you if you are pregnant. Today we talk to Dr. Benjamin Smarr, PhD, who has used sensor data to uncover some of the dynamics of your body in pregnancy. 

You can find Dr. Smarr's work here: https://smarr.ucsd.edu/

The uterus has really lurked in the shadows of gestational research. 

We imagined that it was just a place where the fertilized egg decided to settle and grow. But recent research has recast the uterus in a more prominent role. 

To hear about how this research has overturned what we thought about pregnancy and placental function, I talked with a biologist who has focused on this topic for much of his career. 

A better understanding of the role of the uterus and how the placenta and uterus encourage each other's development in early pregnancy could help us understand infertility, miscarriage and maybe the genesis of some significant pregnancy complications.

You can find Dr. Graham Burton's work here: https://www.trophoblast.cam.ac.uk/people/grahamburton

The how and when of uterine contractions--how are uterine contractions initiated? Whats the trigger or triggers? And when it happens too early, why does it happen too early?  are questions we haven't been able to answer as of yet.  

Or maybe more accurately, we have a bunch of different possible answers, but we don't know how they interact with one another. 

Today I finish my conversation with Dr. Polina Lishko, who shares some of her research on a key mechanism for this trigger, and the other puzzles she and her team have been able to solve by understanding how this particular trigger works.